European consensus statement for intraoperative fluid therapy in children

Area of Science:

• Pediatric Anesthesiology
• Intravenous Fluid Therapy
• Clinical Consensus

Background:

• Intraoperative infusion of 1-2.5% glucose solutions in children is standard practice in many countries but lacks European marketing authorization.
• This regulatory gap leads pediatric anesthesiologists to use suboptimal intravenous fluid strategies, increasing risks of iatrogenic hyponatremia, hyperglycemia, and medical errors.
• Serious morbidity and mortality have been linked to current suboptimal fluid management in pediatric intraoperative care.

Framework:

• A European consensus statement on intraoperative fluid composition for children was developed.
• The statement was discussed at the 2nd Congress of the European Society for Paediatric Anaesthesiology in Berlin, September 2010.
• The German Scientific Working Group for Paediatric Anaesthesia initiated the consensus process.

Implementation:

• Recommended intraoperative fluid osmolarity should be close to the physiologic range for children to prevent hyponatremia.
• Glucose concentration should be 1-2.5% to avoid hypoglycemia, lipolysis, or hyperglycemia, unlike higher concentrations (e.g., 5%).
• Inclusion of metabolic anions (acetate, lactate, or malate) as bicarbonate precursors is advised to prevent hyperchloremic acidosis.

Implications:

• The consensus aims to facilitate European marketing authorization for a standardized intraoperative fluid solution for pediatric use.
• Implementing the recommended fluid composition is expected to improve the safety and effectiveness of intraoperative fluid therapy in children.
• Standardization can reduce medical errors and prevent severe adverse events associated with current fluid management practices.